Healthcare Provider Details

I. General information

NPI: 1609633569
Provider Name (Legal Business Name): LAO FAMILY COMMUNITY DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 3RD ST
SACRAMENTO CA
95814-2301
US

IV. Provider business mailing address

2325 E 12TH ST STE 226
OAKLAND CA
94601-1014
US

V. Phone/Fax

Practice location:
  • Phone: 916-287-0273
  • Fax:
Mailing address:
  • Phone: 510-533-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHY CHAO ROTHBERG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 510-533-8850